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Table 3 Clinical information of patients presenting with rapidly decline renal function/AKI

From: Managing acute presentations of atheromatous renal artery stenosis

  Presentation Co-morbidities Clinical Features Anatomy Intervention Outcome
1 56 yr female referred from another unit with AKI, volume overload and htn Diastolic dysfunction
HTN ( 4 agents)
PVD with claudication distance of < 20 m
CKD (eGFR 29 ml/min)
Smoker
BP: 189/90 mmHg
Creatinine: 1017 µmol/L (AKI on CKD) with hyperkalaemia and metabolic acidosis
MRA
Rt: 100% (8.5 cm)
L: > 80% (10.5 cm)
LPTRAS Immediate ↑ in UO (1.5L/24 h) and ↓ creatinine to 598 µmol/L
1 month:
Creat 115 µmol(eGFR: 44 ml/min)
BP: 149/70 mmHg on 2 agents
RIP 7 years later: no further presentations
4 78 yr female transferred from another institution to our unit with accelerated phase hypertension, deteriorating renal function and pulmonary oedema HTN with LVH
NIDDM
CKD (eGFR 40 ml/min)
History of temporal arteritis
PVD
Diverticular disease
Renal adenocarcinoma requiring L nephrectomy
Bp: 157/80 mmHg on iv diuretic infusion and 4 agents
Volume overloaded
Creatinine: 519 µmol/l (eGFR: 7 ml/min)
MRA
Rt: > 90% (11 cm)
Rt PTRA Within 1 week:
BP < 130/80 mmHg on 2 agents
Independent of RRT with creatinine of 128 µmol/L
5 63 yr male transferred for AKI on CKD CKD 3 (ARVD within previous L PTRAS in 2012)
HTN
Previous ischaemic stroke
NIDDM
Hyperthyroidism treated with radioactive iodine therapy
Smoker
BP: 198/92 mmHg on 3 agents
Creatinine: 319 µmol/L(eGFR: 9 ml/min)
uPCR: 800 mg/mol
Formal Angiogram:
Occluded L stent
L PTRAS
(Fig. 2)
Within 1 month:
BP: < 130/80 mmHg on no agents
Creatinine:240 µmol/L (eGFR: 24 ml/min)
uPCR: 132 mg/mol
9 74 yr female presented acutely with anuric AKI HTN
IHD with angina
Macular degeneration
Smoker
BP 190/90 mmHg
Volume overloaded
Creatinine: 633 µmol/L (eGFR: 6 ml/min)
Renal US:
Rt: 11 cm
L: 8.2 cm
Formal Angiogram:
Rt: > 70%
L: 100%
Rt PTRAS Within 1 month:
BP: < 130/80 mmHg on single agent
Creatinine: 150 µmol/L (eGFR: 31 ml/min)
  1. AKI Acute Kidney Injury, HTN hypertension, PVD peripheral vascular disease, CKD chronic kidney disease, eGFR estimated glomerular filtration rate, BP blood pressure, MRA Magnetic Resonance Angiography, L left, PTRAS percutaneous transluminal renal angioplasty with stenting, UO urinary output, LVH left ventricular hypertrophy, NIDDM non insulin dependent diabetes mellitus, PTRA percutaneous transluminal renal angioplasty, RRT renal replacement therapy, ARVD atheromatous renovascular disease, uPCR urine protein to creatinine ratio, IHD ischaemic heart disease, US ultrasound, Rt right